Amid outcry, Faulkner revises plan to replace inpatient detox unit

Brigham and Women’s Faulkner Hospital is modifying its plan for closing an inpatient drug and alcohol detoxification unit, after the proposal drew heavy criticism from patients, hospital staff, and mental health advocates who said the state has too few such specialized facilities and the change could harm patients.

The hospital had planned to reserve six beds on a medical floor for people with addictions to help offset the beds lost in the closure. In negotiations with the state Department of Public Health, executives have agreed to increase that number to nine and to continue many of the therapeutic services that have been part of the separate unit.

Hospital administrators, who say their plan will allow them to improve care and serve more patients with addictions overall, will re-evaluate the demand for those additional beds after six months and decide whether to maintain them, Edward Liston-Kraft, Faulkner’s vice president of clinical and professional services, said in an interview Tuesday.

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“There are many opinions about how to treat this patient population, and the feedback has been very useful,” Liston-Kraft said.

Hospital administrators will articulate their revised proposal in a response to a March 1 letter from Dr. Madeleine Biondolillo, director of the state Bureau of Health Care Safety and Quality, who wrote that the inpatient addiction services “are necessary for preserving access and health status” in the region served by the Jamaica Plain hospital.

She gave the hospital until March 15 to outline how patient care would change under the proposed compromise and to respond to patient concerns raised at a Feb. 15 public hearing about losing the supportive environment that a dedicated unit provided.

She was optimistic in an interview Tuesday, saying the new proposal “actually serves the patients very, very well—and the right number of patients.”

The state has the authority to review hospitals’ plans to discontinue what are considered “essential” services, including behavioral health care, though it cannot force a facility to continue providing those services.

A physician who works in the detox unit said during the hearing last month that hospital administrators had misrepresented the demand for services on the unit by highlighting that only 10 of the 15 beds are typically filled. She said the hospital only staffed the facility at a level to support 10 patients.

Liston-Kraft said a cap is often in place because patients on the unit have serious medical needs that have not been adequately met even when the hospital has added on-call staff coverage.

About 80 percent of people who call the hospital’s triage line for addiction services are referred to other facilities or outpatient services because their needs are not severe enough to warrant an inpatient stay on the specialized unit, he said. He declined to provide figures on how much of the remaining 20 percent who do qualify for treatment are turned away because there is no bed available for them.

Faulkner’s unit includes 15 of just 26 high-level treatment beds in Boston for people who require the closest monitoring during detox. Mayor Thomas M. Menino had said in a letter read during the hearing that closing it was “too risky” without the same number of beds set aside in the medical unit.

One concern raised during the hearing was how the change would affect the unit’s “Grad Group,” a network of former patients who meet regularly and lend their stories and support to people just entering treatment. Liston-Kraft said that program could continue for those patients now treated in medical beds.

If managed properly, Biondolillo said, locating the detox beds on a medical floor could expand opportunities for doctors-in-training to learn about addiction medicine.

“We thought it made sense to try to find a middle ground,” she said. “I think we got to a good outcome.”

Liston-Kraft and other Partners officials have said repeatedly that the change is not a cost-cutting measure.

“Our intention here is to treat this population at the same level we are, if not more,” he said. “I think it’s going to cost more, but it’s going to get us to see more patients who need it. I think it’s a good plan.”

Stephen Rosenfeld, vice president of the state affiliate of the National Alliance on Mental Illness and a prominent health care attorney, said that he was pleased that the process for reviewing essential health services had allowed for public vetting of big questions raised by Faulkner’s proposal. While he had not yet read the state’s letter, Rosenfeld said last month’s hearing gave those affected by the change “the ability to confront and rebut” administrators’ claims.